Friday, April 4, 2014

When Enough is Never Enough: The Psychology Behind Animal Hoarding.

Petra Kottsieper, Ph.D

If you have been following the regular Philadelphia evening news you may have come across one of the biggest recent animal hoarding cases in Philadelphia, which also made it into some international newspapers.  On March 26, some 239 cats were removed from a double row house in the Frankford section of Philadelphia, after the same person had previously surrendered about 40 of her cats voluntarily.  The woman who lived with and took care of the cats also officially ran an animal rescue group, a situation that very clearly got out of hand.   Hoarding has become popular in recent years with TV shows such as the now cancelled “Hoarders” on A&E, and “Hoarding: Buried Alive” on TLC.  I assume, and I am assuming because I have never watched them, most people watch these shows with a mixture of curiosity and disgust.  It seems, however, that animal hoarding presents its own unique challenges that, until very recently, have not been explored at all.

Hoarding is finally gaining its own entry as a diagnosis in the Diagnostic and Statistical Manual of the American Psychiatric Association, 5th Edition (DSM-5; 2013).   Hoarding disorder, as it is now called, appears to affect between 2-5% of the population.  It furthermore appears to be a distinct disorder and not just a symptom of Obsessive Compulsive Personality Disorder (OCPD) , or Obsessive Compulsive Disorder (OCD).  Hoarding has been referenced in the literature going back all the way to Dante, and was first discussed by psychoanalysts as one of the determinants of having an "anal personality."  In the 1980’s the anal personality construct (also containing orderliness and obstinacy) developed into Obsessive compulsive Personality Disorder.  To make things more difficult hoarding has also been thought and is still thought to be a part of Obsessive Compulsive Disorder.[i]

So now in essence we have 2 types of hoarding categorization. Hoarding disorder in itself and OCD with hoarding behaviors.  Differences between these two manifestations are that in hoarding disorder the accumulation and refusal to discard things (or animals) is often thought to be “normal” by the person and may even be associated with positive experiences. Whereas individuals with OCD who engage in hoarding are more likely to experience their behavior as distressing and not really part of their self-identity. Individuals who clutter are not necessarily hoarders, but individuals who hoard have excessively  cluttered and largely unusable work and living spaces, often resulting in serious health and safety concerns.

Why do people hoard compulsively? Many reasons have been put forth. One example is the belief that individuals who have grown up in poverty or serious deprivation may grow into someone who engages in hoarding.  This theory has not been substantiated by research. Hoarding has been thought of as a pathological excess of capitalism, and several psychoanalytic theories have conceptualized hoarding as a drive to acquire in one’s self-development for a variety of functions.  More recent research has begun to outline psychological and cognitive processes closely related to or may even causally related to some hoarding behavior.  For example, one recent study used functional magnetic resonance imaging to compare neural activity and self-reports in individuals with HD, OCD and individuals with no mental health diagnosis.   It was found that individuals who compulsively hoard exhibited very distinct neural activity in specific brain regions that mapped onto their self-reported and observable psychological states in response to specific stimuli.   Compared to the other two groups, the individuals with HD reported significantly more difficulty with decision making around personal objects they had brought to the study, especially around the emotional value they assign to the objects in question. In addition these same individuals reported experiencing significantly more sadness and anger when thinking about discarding any of these items.[ii]  

Other emerging theoretical approaches have pointed out the importance of a dysfunctional attachment style in individuals who hoard animals.[iii]   Even “normal” animal rescue behavior probably function as a means of deriving meaning and a sense of self as a “good” person. Additionally, rescuing an animal from a "kill shelter" or the streets, which may otherwise mean “death” for the animal, can afford the person a special feeling of control, a sense that individuals who develop hoarding behaviors may not experience in other areas of their lives. These individuals may have disrupted or dysfunctional attachments to other humans, and their attachment to the animals develops into their primary means to build and maintain a sense of self. The control experienced often becomes so extreme (and some have argued delusional) that these individuals believe that no one else can take care of the animals as well as they do, despite evidence of death , disease and squalor all around them.

What does this mean for the woman in our recent local animal hoarding case? Animal hoarding has been described as significantly more difficult to deal with for public health departments as compared to complaints about individuals with non-animal hoarding behaviors.  Individuals who hoard animals are much less willing to cooperate with authorities during the resolution of hoarding complaints leveled against them.  In a very comprehensive overview of animal hoarding, it was noted that animal hoarding largely overlaps with object focused hoarding, but it may constitute even more severe cases , especially as it is often associated with extremely squalid living conditions . 

Individuals who hoard animals often develop the hoarding behavior in middle or older age, as opposed to a younger age as seen in individuals who hoard objects, and they seem to be more often women.  Animal hoarding seems to also be associated with more dysfunctional beliefs and attachments to the animals they hoard as compared to other hoarding situations. Individuals are often unable to bury them or discard the animals even when they are deceased. Furthermore the extreme distress experienced when having to give up the hoarded animal might be greater in individuals who hoard animals as compared to object hoarding. [iv] 

Hoarding in general , but animal hoarding specifically, is in significant need of more research. Very little is known about animal hoarding and the etiology of this possible subtype of hoarding disorder (it is not mentioned as such in the DSM-V).  However, animal hoarding is not an infrequent occurrence, carries not only significant risks to the person and the animals involved but also the nearby community, and can be an expensive and frustrating problem to deal with.  Additionally, animal hoarding has an extremely high relapse rate, reportedly as much as 100% . Historically it has been left to be dealt with by predominantly animal control and law enforcement.  This is clearly an area in dire need of interdisciplinary collaborative efforts and attention from human welfare and mental health agencies. Maybe the inclusion of hoarding disorder as a separate category into the DSM-V will be one important step in this direction.  

In the future I hope to see not only the rescue of the animals from these terribly sad and awful situations, but also envision the provision of (either voluntary or court mandated) help and assistance to the people who very clearly are in need of treatment and relapse prevention.  

[i] Mataix-Cols, D. et al. (2010). Hoarding Disorder: A new disordered for DMS-V?. Depression and Anxiety, 27,  556–572.
[ii] Tolin D.F., Stevens M.C., Villavicencio A.L., et al. (2012). Neural Mechanisms of Decision Making in Hoarding Disorder. Archives of  General  Psychiatry, 69, 832-841.
[iii] Nathanson, J.N. & Patronek, G.J. (2009). A theoretical perspective to inform assessment and treatment strategies for animal hoarders.  Clinical Psychology Review, 29, 274–281.
[iv] Frost, R.O.,  Patronek, G. ,  and Rosenfield, E. (2011). Comparison of object and animal hoarding. Depression and Anxiety, 28, 885–891.